A review of the use of bone morphogenetic protein in 38 cases in 35 patients at high risk for bone healing complications following foot and ankle surgery was performed. Multiple relevant variables were analyzed with respect to the incidence of healing, including age; diabetes mellitus; Charcot neuroarthropathy; prior infection; type of procedure; and the use of femoral head allograft, electrical bone stimulation, and external fixation. The overall incidence of successful healing was 84.21%. A statistically significant decrease in the incidence of bone healing was observed if the patient was 50 years of age or older (P = .03), and all 16 patients younger than 50 years healed their index operation. If 60 years of age was the benchmark, a statistically significant decrease in the rate of healing was observed (P = .02). Logistic regression showed that a 10-year increase in age almost doubled the risk of not healing (odds ratio = 2.613). Furthermore, 4 (66.66%) of the 6 patients who did not heal had diabetes mellitus and were older than 60 years. This combination of risk factors was associated with a statistically significant decrease in the likelihood of bone healing (P < .01). Of the 10 cases to exhibit postoperative drainage, only 50% of these successfully healed, whereas 96% of the remaining 28 cases successfully healed (P = .0026). The results of this study demonstrate the utility of bone morphogenetic proteins in foot and ankle surgical patients at high risk for bone healing complications.
Level of clinical evidence: 2.